January 14, 2021

Everyone is discussing health these days, but here’s an issue you may not be hearing about: California has a severe shortage of children’s mental health workers. There are just not enough competent and well-trained child-serving providers available to meet the mental health care needs of California’s diverse child population, and this is true in both the public and private health insurance sectors. For example, in Medi-Cal, which serves more than half of all kids in California, children must wait 31 days for a psychiatry appointment although regulations require wait times to be no longer than 15 days.

Even when a child is able to get an appointment, not all providers who treat kids are culturally competent and congruent, nor have they been trained through a trauma-informed lens. Examples of negative health outcomes that could result from a lack of culturally competent and congruent care include, but are not limited to: missed opportunities for screening because of lack of familiarity with the prevalence of conditions among certain groups; failure to take into account differing responses to therapies or medication; lack of knowledge about traditional counselors or healers, leading to harmful drug interactions; and diagnostic errors resulting from miscommunication or language access barriers. Therefore, it is just as important for the State to improve the skills and competencies of its current workforce as it is to increase the number of mental health clinicians ready to support children and youth.

While 72% of pediatricians and 63% of family physicians serve Medi-Cal patients, many providers limit the number of Medi-Cal patients they see in order to remain financially viable due to low reimbursement rates. Similarly, within private insurance, many families with a PPO report having difficulties securing a therapist as they are 5.6 times more likely to have a therapist that does not accept their insurance – requiring them to personally take on the cost of therapy. In addition, recent reports cite that 42% of therapists in California do not accept any type of insurance at all, with therapists reporting that plans often deny them the ability to join their networks. As a result, provider networks across private and public insurance are thin, and children and families don’t get the help they need.

 

Expanding and diversifying the mental health workforce

Children’s mental health is especially important now, as our youth are dealing with the stress and uncertainty brought on by the ongoing pandemic, associated school closures, and the resulting social isolation. Meeting the growing needs of children and youth will require the State to expand and diversify the child-serving mental health workforce.

Proposition 63, also known as the Mental Health Services Act (MHSA), offers opportunities to address the mental health workforce. MHSA funding, by design, is made up of five components: Community Services & Support; Prevention & Early Intervention; Innovation; Capital Facilities & Technological Needs; and Workforce Education & Training (WET). With more than $30 million in funding, the goal of the WET component is to develop a diverse workforce. As each county creates its own WET plan, county plans could intentionally and explicitly target child-serving mental health workforce as opposed to the adult-serving workforce.

 

California should develop strategies that include child-serving mental health workers of all types, not just doctors

There are a variety of agencies with responsibility for health care workforce planning within California, including the Office of Statewide Health Planning and Development and the California Future Health Workforce Commission, the Mental Health Services Oversight and Accountability Commission, and agencies in charge of administering health care programs, such as the Department of Health Care Services (DHCS) and the Department of Managed Health Care (DMHC). These agencies must come together to focus on the short- and long-term needs of child-serving health care workers. It’s also critical that any workforce strategy the state implements includes a unique focus on kids as most of the existing initiatives are centered around adults. We cannot expect that initiatives that are designed for adults will serve the needs of kids; kids have their own unique needs, which must be addressed specifically.

We also know that doctors are not always the sole solution to the pediatric mental health workforce problem. For example, peer support specialists can be effective in providing mental health services and connecting those in need to additional supports. In September 2020, Governor Newsom signed Senate Bill 803 (Beall), which would require DHCS to establish (by July 1, 2022) statewide requirements for counties or their representatives to use in developing certification programs for the certification of peer support specialists, who are individuals who self-identify as having lived experience with the process of recovery from mental illness, substance use disorder, or both. This will increase the number of culturally competent individuals who can provide emotional support to youth. We need to look across the spectrum of unmet child health needs, and then determine the best types of providers to bridge and fill the gaps.

 

Looking ahead

This year, Children Now will be providing recommendations to the State on the needed workforce competencies for a robust children’s mental health workforce. In addition to increasing the number of clinicians in clinical and school settings, Children Now will focus on the needed workforce competencies for a robust children’s mental health workforce, which could ensure both the existing and incoming workforce has the skills needed to provide trauma-informed care.